Assessing the Effects of a Paired TBL Session and Patient Simulation on Pharmacy Student HIV Treatment Knowledge

Description of the Problem: Pharmacists can play a crucial role in monitoring, counseling, and providing adherence checks across practice pharmacy settings; but they may not gain experience in this area until after graduating from pharmacy school. Statement of Innovation: Students participated in an intentionally aligned team-based learning session followed by completion of an HIV patient treatment worksheet and an HIV patient care simulation. This sequence was assessed using the HIV Treatment Knowledge Scale. Description of the Innovation: Second-year pharmacy students (N=48, 98% response rate) participated in a baseline knowledge assessment before a four-hour HIV team-based learning (TBL) session, which included the use of an online HIV Patient Management Simulator. Students were administered the scale again post-session. Three days before the simulation, students had access to an HIV patient treatment worksheet that was required to be completed before the simulation. Ten days after the initial assessment, students participated in an HIV patient simulation where they proposed a new antiretroviral plan while also addressing monitoring, barriers, and maximizing adherence for the patient. Post-simulation, students were again administered the scale. Data were analyzed using descriptive statistics, Wilcoxon and paired t-tests, as appropriate. Critical Analysis: A total of 48 second-year pharmacy students participated. HIV knowledge increased significantly post-TBL (p \u3c 0.001). Post-simulation, scores improved, but not significantly (p = 0.291). Knowledge on 15 of the 21 items on the HIV Treatment Knowledge Scale significantly improved from pre-TBL to post-simulation (p ≤ 0.025). Next Steps: Future investigation should focus on the impact that HIV simulation training has on skills, abilities, confidence, and empathy

The Impact of Free Health Screenings at Community Pharmacies on Diabetes

Background: Health screenings can be beneficial when looking to detect diseases early on, thus making treatment easier. Free health screenings are typically performed in the community pharmacy setting. This makes it convenient because it is easily accessible and there is no appointment required. Diabetes is currently one of the most significant health issues faced today, with an estimated 7 million Americans going undiagnosed. Health screenings in community pharmacies are valuable to detect high blood glucose levels for patients to be referred for diagnosis and treatment. Previous studies related to health screenings have focused on hypertension and cholesterol, and few have been conducted on diabetes alone. Extensive research has not been performed regarding patient knowledge of diabetes or on the impact of health screenings. Due to this lack of research and the prevalence of diabetes, it is essential to explore the impact of free health screenings in regards to this growing health care issue. Objective: To assess the impact of free health screenings in community pharmacies on patient follow-up, perceptions, and knowledge of diabetes through blood glucose screenings and patient education. Methods: Data will be collected from local Kroger pharmacies. Patients will be purposefully selected based on inclusion and exclusion criteria. Selected patients will be given a pre-survey at baseline prior to blood glucose testing and diabetes education. Individuals with abnormally high blood glucose levels will be referred to see a physician. Referred participants will be called a month after referral regarding the follow-up with their physician and potential diabetes diagnosis. All of the subjects will be called after a month to remind them to complete the post-survey. The post-survey will be sent to individuals by mail or email a month after the pre-survey. These surveys will contain the exact same questions as the pre-survey

The Impact of Free Health Screenings at Community Pharmacies on Diabetes

Diabetes is a prevalent issue in the United States, with an estimated 8.1 million people un-diagnosed as of 2012. Health screenings have been proven to identify diseases earlier, thereby resulting in earlier and more satisfactory treatment. Community pharmacies can offer many of the same screenings as those in doctor offices. The objective of this study was to assess the impact of free health screenings in community pharmacies on patient follow-up, perceptions, and knowledge of diabetes through blood glucose screenings and patient education. The study design was a pre-post observational study using surveys, blood sugar screenings, and patient education on diabetes. Participants were voluntary patients from four REM Corporation pharmacies in Ohio who were 18 or older, not recently tested for diabetes, non-diabetic, not pregnant, and without disorders that could hinder survey responses and education. Pre- and post-surveys assessed both patient perceptions on free health screenings in community pharmacies and on diabetes knowledge. Results among the 26 participants showed there was no statistically significant difference between patient perception pre- and post-surveys (all p-values ≥ 0.05), however there was a statistically significant difference between pre and post diabetes knowledge surveys (p \u3c 0.001). Limitations of this study were the small sample size due to the relatively small pharmacies utilized and short length of study time. Future directions should focus on using more demographically diverse pharmacies and a longer study time. Due to patients already having highly positive perceptions of health screenings in community pharmacies, future research should assess patient knowledge of diseases and the impact of patient education on overall health outcomes. Results of the study showed patients had positive opinions on free health screenings in community pharmacies and these screenings can help patients understand disease states and be more aware of their health

Survey of Community Pharmacy Customers’ Medication Storage and Disposal Methods

Many people store medications in bathrooms, which provide a moist, humid environment that speeds up the breakdown process of medications. The proper way to store medicines is in a cool, dry place out of the reach of children. Every year medications are also disposed of improperly presenting a risk to both humans and the environment. About one-third of all sold medications are unused. The most common ways patients dispose of medications in the United States are flushing down the toilet or sink, and throwing them away. Because of this pharmaceuticals have been found in groundwater, and drinking water proving hazardous to both humans and ecosystems. In Congress today, both the Drug Free Water Act and the Safe Drug Disposal Act have been proposed to limit the disposal of pharmaceuticals in sewage systems, and provide the means of controlled substance disposal through take-back programs. In February 2007 the White House Office of National Drug Control Policy (ONDCP) established guidelines for the disposal of prescription medications. ONDCP guidelines are: take unused, unneeded or expired medications out of the original container, mix with an undesirable substance (such as coffee grounds), securely seal in impermeable containers, such as sealable bags, and throw into the trash. ONDCP recommends only flushing if the label or patient information specifies to do so. Taking advantage of community pharmaceutical take-back programs is highly encouraged

The Correlation of Free Health Screenings at Community Pharmacies on Diabetes

Objective: To assess the correlation of free health screenings in community pharmacies on patient perceptions of free health screenings and diabetes knowledge. Methods: The study design was a pre-post observational study using surveys, blood sugar screenings, and patient education on diabetes. Participants were voluntary patients from four REM Corporation pharmacies in Ohio who were 18 or older, not recently tested for diabetes, non-diabetic, not pregnant, and without disorders that could hinder survey responses and education. Pre- and post-surveys assessed both patient perceptions on free health screenings in community pharmacies and on diabetes knowledge. Results: Among the 26 participants there was no statistically significant difference between patient perception pre- and post-surveys (all p-values ≥0.05), however there was a statistically significant difference between pre and post diabetes knowledge surveys (p<0.001). Conclusion: Patients have positive opinions on free health screenings in community pharmacies and these screenings can help patients understand disease states and be more aware of their health.   Type: Original Researc

The melanoma-specific graded prognostic assessment does not adequately discriminate prognosis in a modern population with brain metastases from malignant melanoma

The melanoma-specific graded prognostic assessment (msGPA) assigns patients with brain metastases from malignant melanoma to 1 of 4 prognostic groups. It was largely derived using clinical data from patients treated in the era that preceded the development of newer therapies such as BRAF, MEK and immune checkpoint inhibitors. Therefore, its current relevance to patients diagnosed with brain metastases from malignant melanoma is unclear. This study is an external validation of the msGPA in two temporally distinct British populations.Performance of the msGPA was assessed in Cohort I (1997-2008, n=231) and Cohort II (2008-2013, n=162) using Kaplan-Meier methods and Harrell's c-index of concordance. Cox regression was used to explore additional factors that may have prognostic relevance.The msGPA does not perform well as a prognostic score outside of the derivation cohort, with suboptimal statistical calibration and discrimination, particularly in those patients with an intermediate prognosis. Extra-cerebral metastases, leptomeningeal disease, age and potential use of novel targeted agents after brain metastases are diagnosed, should be incorporated into future prognostic models.An improved prognostic score is required to underpin high-quality randomised controlled trials in an area with a wide disparity in clinical care

Aberrant immunoglobulin class switch recombination and switch translocations in activated B cell–like diffuse large B cell lymphoma

To elucidate the mechanisms underlying chromosomal translocations in diffuse large B cell lymphoma (DLBCL), we investigated the nature and extent of immunoglobulin class switch recombination (CSR) in these tumors. We used Southern blotting to detect legitimate and illegitimate CSR events in tumor samples of the activated B cell–like (ABC), germinal center B cell–like (GCB), and primary mediastinal B cell lymphoma (PMBL) subgroups of DLBCL. The frequency of legitimate CSR was lower in ABC DLBCL than in GCB DLBCL and PMBL. In contrast, ABC DLBCL had a higher frequency of internal deletions within the switch μ (Sμ) region compared with GCB DLBCL and PMBL. ABC DLBCLs also had frequent deletions within Sγ and other illegitimate switch recombinations. Sequence analysis revealed ongoing Sμ deletions within ABC DLBCL tumor clones, which were accompanied by ongoing duplications and activation-induced cytidine deaminase–dependent somatic mutations. Unexpectedly, short fragments derived from multiple chromosomes were interspersed within Sμ in one case. These findings suggest that ABC DLBCLs have abnormalities in the regulation of CSR that could predispose to chromosomal translocations. Accordingly, aberrant switch recombination was responsible for translocations in ABC DLBCLs involving BCL6, MYC, and a novel translocation partner, SPIB

No Differences in Soil Carbon Stocks Across the Tree Line in the Peruvian Andes

ABSTRACT Reliable soil organic carbon (SOC) stock measurements of all major ecosystems are essential for predicting the influence of global warming on global soil carbon pools, but hardly any detailed soil survey data are available for tropical montane cloud forests (TMCF) and adjacent high elevation grasslands above (puna). TMCF are among the most threatened of ecosystems under current predicted global warming scenarios. We conducted an intensive soil sampling campaign extending 40 km along the tree line in the Peruvian Andes between 2994 and 3860 m asl to quantify SOC stocks of TMCF, puna grassland, and shrubland sites in the transition zone between the two habitats. SOC stocks from the soil surface down to the bedrock averaged (±standard error SE) 11.8 (±1.5, N = 24) kg C/m 2 in TMCF, 14.7 (±1.4, N = 9) kg C/m 2 in the shrublands and 11.9 (±0.8, N = 35) kg C/m 2 in the grasslands and were not significantly different (P > 0.05 for all comparisons). However, soil profile analysis revealed distinct differences, with TMCF profiles showing a uniform SOC distribution with depth, shrublands a linear decrease, and puna sites an exponential decrease in SOC densities with soil depth. Organic soil layer thickness reached a maximum ($70 cm) at the upper limit of the TMCF and declined with increasing altitude toward puna sites. Within TMCF, no significant increase in SOC stocks with increasing altitude was observed, probably because of the large variations among SOC stocks at different sites, which in turn were correlated with spatial variation in soil depth